Background: In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential. Aside from factors related to access and knowledge about diverse and adequate diets, inequitable gender norms and women’s low status and autonomy also feed into a lack of emphasis on women’s nutrition.Methods: In this paper we describe the three phases of the design of an intervention for newly married women, their husbands, and mothers-in-law in rural Nepal. We first discuss findings from a mixed methods formative phase, and how that fed into the design of the intervention itself, in close partnership with community members. We the describe the intervention, and findings from a mixed methods feasibility and acceptability pilot among 90 participants.Results: Our formative work highlighted not just lack of awareness about nutrition, but also how factors such as women eating last, and limited mobility, played into poor diets. Low lack of communication and household and community inequitable gender norms were also important factors. Thus we designed Sumadhur, an intervention that brought groups of households (newly married wife, husband, and mother-in-law) together weekly for 4 months to strengthen relationships and gain knowledge through interactive content. We found Sumadhur to be highly feasible and acceptable by all respondents, with most (83%) attending 80% of sessions or more, the majority (73%) of participants reported “no difficulties” in attending sessions, and 99% reporting that they would like it to continue. Pre/post surveys showed a decrease in the proportion of women of women eating last and increase in knowledge about nutrition in preconception and pregnant. Qualitative interviews suggested that respondents felt it made large impacts on their lives, in terms of strengthening relationships and trust, understanding each other, and changing behaviors.Conclusions: We show how a designing an intervention in close partnership with the target recipients and local stakeholders can lead to an intervention that is able to target complicated and culturally held practices and beliefs, positively benefit health and wellbeing, and that is very well received.Trial registration: ClinicalTrials.gov NCT04383847, registered 05/12/2020https://clinicaltrials.gov/ct2/show/results/NCT04383847?view=results

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Background Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making. Methods In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired t-tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically. Results Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges. Conclusions Entrenched social norms surrounding fertility and family planning contrasted with participants’ personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

Background Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making. Methods In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically. Results Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges. Conclusions Entrenched social norms surrounding fertility and family planning contrasted with participants’ personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

Background: In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential. Aside from factors related to access and knowledge about diverse and adequate diets, inequitable gender norms and women’s low status and autonomy also feed into a lack of emphasis on women’s nutrition.Methods: In this paper we describe the three phases of the design of an intervention for newly married women, their husbands, and mothers-in-law in rural Nepal. We first discuss findings from a mixed methods formative phase, and how that fed into the design of the intervention itself, in close partnership with community members. We the describe the intervention, and findings from a mixed methods feasibility and acceptability pilot among 90 participants.Results: Our formative work highlighted not just lack of awareness about nutrition, but also how factors such as women eating last, and limited mobility, played into poor diets. Low lack of communication and household and community inequitable gender norms were also important factors. Thus we designed Sumadhur, an intervention that brought groups of households (newly married wife, husband, and mother-in-law) together weekly for 4 months to strengthen relationships and gain knowledge through interactive content. We found Sumadhur to be highly feasible and acceptable by all respondents, with most (83%) attending 80% of sessions or more, the majority (73%) of participants reported “no difficulties” in attending sessions, and 99% reporting that they would like it to continue. Pre/post surveys showed a decrease in the proportion of women of women eating last and increase in knowledge about nutrition in preconception and pregnant. Qualitative interviews suggested that respondents felt it made large impacts on their lives, in terms of strengthening relationships and trust, understanding each other, and changing behaviors.Conclusions: We show how a designing an intervention in close partnership with the target recipients and local stakeholders can lead to an intervention that is able to target complicated and culturally held practices and beliefs, positively benefit health and wellbeing, and that is very well received.Trial registration: ClinicalTrials.gov NCT04383847, registered 12/05/2020https://clinicaltrials.gov/ct2/show/results/NCT04383847?view=results